Letter

MJA 2001; 175: 670-671

T. solium (pork tapeworm) is associated with two distinct infective states in humans: asymptomatic intestinal infection by an adult tapeworm, and cysticercosis, which is associated with clinical disease. Ingestion of eggs in contaminated food or water by an intermediate host, typically pigs but sometimes humans, leads to the development of cysticercosis, as seen in our patient. Humans acquire intestinal infection with the adult tapeworm by ingesting encysted larvae (cysticerci) in undercooked meat.^1-3

Epilepsy is the most common presentation.^1,2,4 The findings of cysticerci outside the central nervous system (such as in the posterior chamber of the eye, palpable within subcutaneous tissues, or as calcified nodules on plain x-rays) and the detection of anticysticercal antibodies in plasma or cerebrospinal fluid may assist in diagnosis of neurocysticercosis, and subsequently prevent unnecessary neurosurgery. However, patients with a single cerebral lesion or those with only calcified lesions are commonly seronegative.^1-3 Stool examination for tapeworm eggs is insensitive, but may identify patients with intestinal infection.²

Whether treatment with praziquantel or albendazole improves long term outcome remains controversial.^2,5 In cases of encephalitis, subarachnoid, spinal or ocular involvement, symptoms may worsen secondary to an inflammatory reaction around degenerating cysts. Co-administration of corticosteroids ameliorates some of this effect. Surgical treatment is reserved for patients with hydrocephalus.^1-3

Neurocysticercosis is uncommon in Australia.⁵ Our case reminds us of the risks of infective diseases posed to travellers and migrants. It also highlights the importance of considering infective causes such as cysticerci, bacterial abscesses, toxoplasmosis and cryptococcomas in the differential diagnosis of space-occupying lesions seen on central nervous system imaging.

Anthony T Zimmermann,* William S Jeffries
* General Medicine Advanced Trainee, Repatriation General Hospital, Daws Road, Daw Park, SA, 5041
  General Physician, Lyell McEwin Hospital, Elizabeth, SA
atzimmATausdoctors.net

1. Garcia HH, Del Brutto OH. Taenia solium cysticercosis. Infect Dis Clin North Am 2000; 14: 97-119.
2. Garg RK. Neurocysticercosis. Postgrad Med J 1998; 74: 321-326.
3. Pluschke M, Bennett G. Orbital cysticercosis. Aust N Z J Ophthalmol 1998; 26: 333-336.
4. White AC Jr. Neurocysticercosis: a major cause of neurological disease worldwide. Clin Infect Dis 1997; 24: 101-115.
5. Hellard ME, Street AC, Johnson PDR, et al. Detection of an aberrant motile larval form in the brain of a patient with neurocysticercosis. Clin Infect Dis 1998; 27: 391-393.

©MJA 2001
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